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Account Balance Transfer
National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners: 45 CFR Part 60 Regulations and Forms
OMB: 0915-0126
IC ID: 229941
OMB.report
HHS/HSA
OMB 0915-0126
ICR 202310-0915-003
IC 229941
( )
Documents and Forms
Document Name
Document Type
Form 39
Account Balance Transfer
Form and Instruction
39 Account Balance Transfer.pdf
Account Balance Transfer.pdf
Form and Instruction
Information Collection (IC) Details
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